| Gina Simon Lisw, Pc | |
|
2729 Mesilla St Ne Albuquerque NM 87110-3539 | |
| (505) 249-8764 | |
| Not Available |
| Full Name | Gina Simon Lisw, Pc |
|---|---|
| Speciality | Social Worker |
| Location | 2729 Mesilla St Ne, Albuquerque, New Mexico |
| Authorized Official Name and Position | Gina Simon (PRESIDENT) |
| Authorized Official Contact | 5052498764 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gina Simon Lisw, Pc 2729 Mesilla St Ne Albuquerque NM 87110-3539 Ph: (505) 249-8764 | Gina Simon Lisw, Pc 2729 Mesilla St Ne Albuquerque NM 87110-3539 Ph: (505) 249-8764 |
| NPI Number | 1689860462 |
|---|---|
| Provider Enumeration Date | 09/14/2007 |
| Last Update Date | 04/27/2023 |
| Certification Date | 04/27/2023 |
| Medicare PECOS PAC ID | 9830497874 |
|---|---|
| Medicare Enrollment ID | O20160830000513 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689860462 | NPI | - | NPPES |
| D4495 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | I-3207 (New Mexico) | Primary |
| Provider Name | Gina K Simon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942351580 PECOS PAC ID: 3274760152 Enrollment ID: I20131223000118 |
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